Journal Article

Systematic review of psychotherapy for adults with functional neurological disorder

Gutkin, Myles, McLean, Loyola, Kanaan, Richard A, Brown, Richard

2021

Overview

Functional neurological disorder (FND) is a common and disabling disorder that is often considered difficult to treat, particularly in adults. Psychological therapies are often recommended for FND. Outcome research on psychological therapies for FND has grown in recent years but has not been systematically evaluated since 2005. This study aims to build on that by systematically reviewing the evidence-base for individual outpatient cognitive behavioural and psychodynamic psychotherapies for FND. Medical databases were systematically searched for prospective studies of individual outpatient psychotherapy for FND with at least five adult participants. Studies were assessed for methodological quality using a standardised assessment tool. Results were synthesised, and effect sizes calculated for illustrative purposes. The search strategy identified 131 relevant studies, of which 19 were eligible for inclusion: 12 examining cognitive behavioural therapy (CBT) and 7 investigating psychodynamic therapy (PDT). Eleven were pre–post studies and eight were randomised controlled trials. Most studies recruited a single symptom-based subtype rather than all presentations of FND. Effect sizes, where calculable, showed generally medium-sized benefits for physical symptoms, mental health, well-being, function and resource use for both CBT and PDT. Outcomes were broadly comparable across the two therapy types, although a lack of high-quality controlled trials of PDT is a significant limitation, as is the lack of long-term follow-up data in the majority of identified CBT trials. In conclusion, both CBT and PDT appear to potentially offer some benefit for FND, although better quality studies are needed.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Cognitive behavioral therapy / conversion disorder / Convulsions & seizures / functional neurological disorder / Hypothesis testing / Intervention / Mental disorders / Mental health care / Neurological disorders / Neuropsychiatry / psychology / Psychotherapy / Quality of life / somatisation disorder / Systematic review / Well being